Skeletal measuring means

ABSTRACT

An integrated imaging system is invented for creating an optimal imaging session by importing information in real time from several sources and using that information to automatically and continuously adjust the parameters of the imaging session so as to create the optimal session for the prescribed testing session

CROSS-REFERENCE

This application is a continuation application of U.S. patentapplication Ser. No. 14/828,077, now U.S. Pat. No. _____ issued _____which is a divisional application of U.S. patent application Ser. No.13/497,386 filed on Jul. 9, 2012, under 35 USC §371, now U.S. Pat. No.9,138,163 issued Sep. 22, 2015 which claims the benefit of InternationalApplication PCT/US2010/050210 filed on Sep. 24, 2010, under 35 USC §365,which claims the benefit of U.S. Provisional Application No. 61/245,984filed Sep. 25, 2009, which applications are incorporated herein byreference.

BACKGROUND OF THE INVENTION

One of the most prevalent joint problems is back pain, particularly inthe “small of the back” or lumbosacral (L4-S1) region. In many cases,the pain severely limits a person's functional ability and quality oflife. Such pain can result from a variety of spinal pathologies. Throughdisease or injury, the vertebral bodies, intervertebral discs, laminae,spinous process, articular processes, or facets of one or more spinalvertebrae can become damaged, such that the vertebrae no longerarticulate or properly align with each other. This can result in anundesired anatomy, loss of mobility, and pain or discomfort. DukeUniversity Medical Center researchers found that patients suffering fromback pain in the United States consume more than $90 billion annually inhealth care expenses, with approximately $26 billion being directlyattributable to treatment. Additionally, there is a substantial impacton the productivity of workers as a result of lost work days. Similartrends have also been observed in the United Kingdom and othercountries. As a result of this problem, increased funding is beingapplied toward developing better and less invasive orthopedicintervention devices and procedures.

Over the years the increased funding has led to the development ofvarious orthopedic interventions. These include interventions suitablefor fixing the spine and/or sacral bone adjacent the vertebra, as wellas attaching devices used for fixation, including: U.S. Pat. No.6,290,703, to Ganem, for Device for Fixing the Sacral Bone to AdjacentVertebrae During Osteosynthesis of the Backbone; U.S. Pat. No.6,547,790, to Harkey, III, et al., for Orthopaedic Rod/Plate LockingMechanisms and Surgical Methods; U.S. Pat. No. 6,074,391, toMetz-Stavenhagen, et al., for Receiving Part for a Retaining Componentof a Vertebral Column Implant; U.S. Pat. No. 5,891,145, to Morrison, etal., for Multi-Axial Screw; U.S. Pat. No. 6,090,111, to Nichols, forDevice for Securing Spinal Rods; U.S. Pat. No. 6,451,021, to Ralph, etal., for Polyaxial Pedicle Screw Having a Rotating Locking Element; U.S.Pat. No. 5,683,392, to Richelsoph, et al., for Multi-Planar LockingMechanism for Bone Fixation; U.S. Pat. No. 5,863,293, to Richelsoph, forSpinal Implant Fixation Assembly; U.S. Pat. No. 5,964,760, toRichelsoph, for Spinal Implant Fixation Assembly; U.S. Pat. No.6,010,503, to Richelsoph, et al., for Locking Mechanism; U.S. Pat. No.6,019,759, to Rogozinski, for Multi-Directional Fasteners or AttachmentDevices for Spinal Implant Elements; U.S. Pat. No. 6,540,749, toSchafer, et al., for Bone Screw; U.S. Pat. No. 6,077,262, to Schlapfer,for Posterior Spinal Implant; U.S. Pat. No. 6,248,105, to Schlapfer, etal., for Device for Connecting a Longitudinal Support with a PedicleScrew; U.S. Pat. No. 6,524,315, to Selvitelli, et al., for OrthopaedicRod/Plate Locking Mechanism; U.S. Pat. No. 5,797,911, to Sherman, etal., for Multi-Axial Bone Screw Assembly; U.S. Pat. No. 5,879,350, toSherman, et al., for Multi-Axial Bone Screw Assembly; U.S. Pat. No.5,885,285, to Simonson, For Spinal Implant Connection Assembly; U.S.Pat. No. 5,643,263, to Simonson for Spinal Implant Connection Assembly;U.S. Pat. No. 6,565,565, to Yuan, et al., for Device for Securing SpinalRods; U.S. Pat. No. 5,725,527, to Biederman, et al., for AnchoringMember; U.S. Pat. No. 6,471,705, to Biederman, et al., for Bone Screw;U.S. Pat. No. 5,575,792, to Errico, et al., for Extending Hook andPolyaxial Coupling Element Device for Use with Top Loading Rod FixationDevices; U.S. Pat. No. 5,688,274, to Errico, et al., for Spinal ImplantDevice having a Single Central Rod and Claw Hooks; U.S. Pat. No.5,690,630, to Errico, et al., for Polyaxial Pedicle Screw; U.S. Pat. No.6,022,350, to Ganem, for Bone Fixing Device, in Particular for Fixing tothe Sacrum during Osteosynthesis of the Backbone; U.S. Pat. No.4,805,602, to Puno, et al., for Transpedicular Screw and Rod System;U.S. Pat. No. 5,474,555, to Puno, et al., for Spinal Implant System;U.S. Pat. No. 4,611,581, to Steffee, for Apparatus for StraighteningSpinal Columns; U.S. Pat. No. 5,129,900, to Asher, et al., for SpinalColumn Retaining Method and Apparatus; U.S. Pat. No. 5,741,255, to Krag,et al., for Spinal Column Retaining Apparatus; U.S. Pat. No. 6,132,430,to Wagner, for Spinal Fixation System; U.S. Patent No. 7,780,703, and toYuan, et al., for Device for Securing Spinal Rods.

Another type of orthopedic intervention is the spinal treatmentdecompressive laminectomy. Where spinal stenosis (or other spinalpathology) results in a narrowing of the spinal canal and/or theintervertebral foramen (through which the spinal nerves exit the spine),and neural impingement, compression and/or pain results, the tissue(s)(hard and/or soft tissues) causing the narrowing may need to be resectedand/or removed. A procedure which involves excision of part or all ofthe laminae and other tissues to relieve compression of nerves is calleda decompressive laminectomy. See, for example, U.S. Pat. No. 5,019,081,to Watanabe, for Laminectomy Surgical Process; U.S. Pat. No. 5,000,165,to Watanabe, for Lumbar Spine Rod Fixation System; and U.S. Pat. No.4,210,317, to Spann, et al., for Apparatus for Supporting andPositioning the Arm and Shoulder. Depending upon the extent of thedecompression, the removal of support structures such as the facetjoints and/or connective tissues (either because these tissues areconnected to removed structures or are resected to access the surgicalsite) may result in instability of the spine, necessitating some form ofsupplemental support such as spinal fusion, discussed above.

Other orthopedic interventional techniques and processes have also beendeveloped to treat various spinal and joint pathologies. For example,U.S. Patent Nos. 6,726,691 to Osorio for Methods and devices fortreating fractured and/or diseased bone; U.S. Pat. No. 7,155,307 toScribner for Systems and methods for placing materials into bone; U.S.Pat. No. 7,241,303 to Reiss for Devices and methods using an expandablebody with internal restraint for compressing cancellous bone; and U.S.Patent Pubs. 2005/0240193 to Layne for Devices for creating voids ininterior body regions and related methods; 2006/0149136 to Seto forElongating balloon device and method for soft tissue expansion;2007/0067034 to Chirico for Implantable Devices and Methods for TreatingMicro-Architecture Deterioration of Bone Tissue; 2006/0264952 to Nelsonfor Methods of Using Minimally Invasive Actuable Bone Fixation Devices.

Health care providers rely on an understanding of joint anatomy andmechanics when evaluating a subject's suspected joint problem and/orbiomechanical performance issue. Understanding anatomy and jointbiomechanics assists in the diagnosis and evaluation of a subject for anorthopedic intervention. However, currently available diagnostic toolsare limited in the level of detail and analysis that can be achieved.Typically, when treating joint problems, the intention is to address aspecific structural or mechanical problem within the joint. For example,a surgeon might prescribe a spinal fusion procedure to physicallyimmobilize the vertebra of a subject suffering from vertebralinstability, or a physical therapist might prescribe exercises tostrengthen a specific tendon or muscle that is responsible for a jointproblem, etc.

It follows, therefore, that the extent to which a specific treatablejoint defect can be identified and optimally treated directly impactsthe success of any treatment protocol. Currently available orthopedicdiagnostic methods are capable of detecting a limited number of specificand treatable defects. These techniques include X-Rays, MRI,discography, and physical exams of the patient. In addition, spinalkinematic studies such as flexion/extension X-rays are used tospecifically detect whether or not a joint has dysfunctional motion.These methods have become widely available and broadly adopted into thepractice of treating joint problems and addressing joint performanceissues. However, currently available diagnostic techniques providemeasurement data that is imprecise and often inconclusive which resultsin an inability to detect many types of pathologies or accurately assesspathologies that might be considered borderline. As a result, asignificant number of patients having joint problems remain undiagnosedand untreated using current techniques, or worse are misdiagnosed andmistreated due to the poor clinical efficacy of these techniques.

For example, currently available techniques for conducting spinalkinematic studies are often unable to determine whether a jointdysfunction is a result of the internal joint structure per se, orwhether the dysfunction is a result of, or significantly impacted by,the surrounding muscular tissue. Additionally, there are no reliabletechniques for identifying soft tissue injury. Muscle guarding is a wellestablished concept that is hypothesized to be highly prevalent amongsufferers of joint pain, specifically that of the neck and back. Inmuscle guarding, a subject responds to chronic pain by immobilizing thepainful area through involuntary muscle involvement. The ability toisolate different muscle groups is desirable to determine which musclegroup or combination of groups, if any, could be contributing to, orresponsible for, any joint dysfunction.

Additionally, the level of entrenchment of muscle guarding behaviorcannot currently be determined. With respect to treatment decisions, theoperative question in determining the level of “entrenchment” of anyobserved muscle guarding is to determine if the muscle guarding behavioris one which conservative methods of therapy could address throughnon-surgical therapy, or alternatively determining that the muscleguarding behavior so “entrenched” that such efforts would be futile andsurgery should be considered.

In some instances, joint dysfunctions may not always present themselvesin the movements traditionally measured during spinal kinematic studiessuch as flexion-extension and side-bending in either “full”non-weight-bearing or “full” weight-bearing planes of movement, whichcorrespond to lying down and standing up postures respectively. Certainpainful movements occur during joint rotation when the plane of rotationis somewhere between these two postures. Certain other painful movementsonly occur when the subject is rotating his or her spine while in a bentposture. In the case of vertebral motion in full weight-bearingpostures, gravitational forces are relatively evenly distributed acrossthe surface area of the vertebrae. However in postures where the subjectis standing with his/her spine bent, gravitational forces areconcentrated on the sections of the vertebrae located toward thedirection of the bend. Detecting motion dysfunctions that occur onlywhen in a standing bent posture requires the replication of joint motionin that specific bent posture in a controlled, repeatable, andmeasurable manner during examination.

Further, assuming that a system of measuring the surface motion ofjoints and the motion between internal joint structures that accountsfor various types of muscle involvements would be possible, there wouldbe a need for investigational data from controlled clinical trials to becollected across a broad population of subjects to afford forcomparative analyses between subjects. Such a comparative analysisacross a broad population of subjects would be necessary for the purposeof defining “normal” and “unhealthy” ranges of such measurements, whichwould in turn form the basis for the diagnostic interpretation of suchmeasurements.

There have been significant technological innovations to the field oforthopedic interventions over the last few decades, specifically withthe use of prosthetic and therapeutic devices to correct mechanical andstructural defects of the bones and joints and to restore proper jointfunction. There have also been significant advances in the applicationof chiropractic and physical therapy approaches to correct muscle-,ligament-, and tendon-related defects. There has not however, been acorresponding improvement in the diagnostic methods used to identifyproper candidates for these interventions. As a result, the potentialimpact and utility of the improvements in orthopedic intervention hasbeen limited.

Imaging is the cornerstone of all modern orthopedic diagnostics. Thevast majority of diagnostic performance innovations have focused onstatic images. Static images are a small number of images of a jointstructure taken at different points in the joint's range of motion, withthe subject remaining still in each position while the image is beingcaptured. Static imaging studies have focused mainly on detectingstructural changes to the bones and other internal joint structures. Anexample of the diagnostic application of static imaging studies is withthe detection of spinal disc degeneration by the use of plain X-rays, MRimages and discograms. However, these applications yield poor diagnosticperformance with an unacceptably high proportion of testing eventsyielding either inconclusive or false positive/false negative diagnosticresults (Lawrence, J. S. (1969) Annals of Rheumatic Diseases 28: 121-37;Waddell, G. (1998) The Back Pain Revolution. Edinburgh, ChurchillLivingstone Ch2 p 22; Carragee et al. (2006) Spine 31(5): 505-509,McGregor et al. (1998) J Bone Joint Surg (Br) 80-B: 1009-1013; Fujiwaraet al. (2000(a)) Journal of Spinal Disorders 13: 444-50).

Purely qualitative methods for visualizing joint motion have beenavailable for some time using cine-radiography (Jones, M. D. (1962)Archives of Surgery 85: 974-81). More recently, computer edge extractionof vertebral images from fluoroscopy has been used to improve thisvisualization for use in animations (Zheng et al. (2003) MedicalEngineering and Physics 25: 171-179). These references do not, however,provide for any form of measurement or identification of objectivelydefined motion abnormalities, and therefore is of very limiteddiagnostic value other than in the detection of grossly and visiblyobvious abnormalities that would be detectable using static imageanalysis methods. Without any quantitative or objective measurementparameters defined, it is impossible to utilize such approaches incomparative analyses across wide populations of subjects, which isrequired for the purpose of the producing definitive diagnosticinterpretations of the results as being either “normal” or “unhealthy”.Further, there have been no diagnostically useful validations ofqualitative motion patterns that are generally absent in non-sufferersbut present in subjects suffering from known and specific jointfunctional derangements or symptoms, or vice versa.

A method for determining vertebral body positions using skin markers wasdeveloped (Bryant (1989) Spine 14(3): 258-65), but could only measurejoint motion at skin positions and could not measure the motion ofstructures within the joint. There have been many examples skin markerbased spine motion measurement that have all been similarly flawed.

Methods have been developed to measure changes to the position ofvertebrae under different loads in dead subjects, whose removed spineswere fused and had markers inserted into the vertebrae (Esses et al.(1996) Spine 21(6): 676-84). The motion of these markers was thenmeasured in the presence of different kinds of loads on the vertebrae.This method is, however, inherently impractical for clinical diagnosticuse. Other methods with living subjects have been able to obtain a highdegree of accuracy in measuring the motion of internal joint structuresby placing internal markers on the bones of subjects and digitallymarking sets of static images (Johnsson et al. (1990) Spine 15: 347-50),a technique known as roentgen stereophotogrammetry analysis (RSA).However RSA requires the surgical implantation of these markers intosubjects' internal joint structures, requires the use of tworadiographic units simultaneously, and requires a highly complicatedcalibration process for every single test, and therefore is too invasiveand too cumbersome a process for practicable clinical application.

Cine-radiography of uncontrolled weight-bearing motion (Harada et al(2000) Spine 25: 1932-7; Takavanagi et al. (2001) Spine 26(17):1858-1865) has been used to provide a set of static images to whichdigital markers have been attached and transformed to give quantitativemeasurement of joint motion. Similar measurement of joint motion hasbeen achieved using videofluoroscopy (Breen et al. (1989) Journal ofBiomedical Engineering 11: 224-8; Cholewicki et al. (1991) ClinicalBiomechanics 6: 73-8; Breen et al. (1993) European Journal of PhysicalMedicine and Rehabilitation 3(5): 182-90; Brydges et al. 1993). Thismethod has also been used to study the effects on joint motion ofweightlifting (Cholewicki, J. and S. M. McGill (1992) Journal ofBiomechanics 25(1): 17-28). The prior art using this method involves amanual process in which internal joint structures are marked by handwith digital landmarks on digital image files of consecutive frames ofvideoflouroscopy recordings of a subject's joint motion. A computer thenautomatically determines the frame-to-frame displacement between suchdigital landmarks to derive quantitative measurements of the motion ofjoint structures (Lee et al. (2002) Spine 27(8): E215-20). Even morerecently, this approach has been accomplished using an automaticregistration process (Wong et al. (2006) Spine 31(4): 414-419) thateliminates the manual marking process and thus reduces the laboriousnessof the previous processes. However both of these methods, as well as allof the other methods mentioned in this paragraph, studied the motion ofjoints based on the imaging of uncontrolled, weight-bearing body motion.

Using uncontrolled, weight-bearing motion to derive quantitativemeasurements of joint motion confounds the diagnostic interpretation ofsuch measurements so as to render them diagnostically useless. Thediagnostic interpretation of such measurements would normally be basedon a comparative analysis of joint motion measurements across a widepopulation of subjects, and would strive to identify statisticallysignificant differences in these measurements between “normal” and“unhealthy” subjects, such that any given subject can be classified as“normal” or “unhealthy” based on that subject's joint motion measurementvalues. For such purposes, it is necessary to reduce the backgroundvariability of measurements across tested subjects as much as possible,so that any observed difference between “normal” and “unhealthy”subjects can be definitively attributable to a specific condition. Notcontrolling the motion that is being studied introduces variability intothese comparative analyses due to differences that exist across testingsubjects with respect to each subject's individual range of motion,symmetry of motion, and regularity of motion. These differences affectthe joint motion of each subject differently, and collectively serve tocreate wide variability among joint motion measurements across subjects.Controlling for these factors by ensuring a consistent, regular, andsymmetric body part motion during diagnostic testing serves to minimizethe effects of these factors on a subject's relevant joint motionmeasurements, thereby reducing the variability of such measurementsacross subjects and therefore increasing the likelihood that suchmeasurements will yield useful diagnostic results.

In addition to failing to control motion during testing, not accountingfor the involvement and effects of muscles that are acting when asubject moves under their own muscular force while in a weight-bearingstance further adds to this variability by introducing such inherentlyvariable factors such as the subject's muscle strength, level of pain,involuntary contraction of opposing muscle groups, and neuro-muscularco-ordination. Taken together, all of these sources of variability serveto confound diagnostic conclusions based on comparative analyses bymaking the ranges of “normal” and those of “abnormal” difficult todistinguish from one another other in a statistically significant way.Such an inability to distinguish between “normal” and “unhealthy”subjects based on a specific diagnostic measurement renders such ameasurement diagnostically useless, as has been the case heretofore inthe prior art which has focused on measurements of uncontrolled jointmotion measured in subjects in weight-bearing postures and moving theirjoints through the power of their own muscles and in an uncontrolledfashion.

U.S. Pat. No. 7,000,271 discloses a tilting table capable of somemovement to keep an iso-center at a fixed position. U.S. Pat. No.:7,343,635 describes a multi-articulated tilting table which positionsand supports a subject during examination and treatment. U.S. Pat. No.7,502,641 to Breen discloses a device for controlling joint motion andminimizing the effects of muscle involvement in the joint motion beingstudied. This device minimizes variability among joint motionmeasurements across wide populations of subjects. As a result,comparative analyses of such measurements can be performed to determinestatistical differences between the motion of “normal” and “unhealthy”subjects which in turn can provide a basis for determining thestatistical confidence with which any given subject could be considered“normal” or “unhealthy” based solely on joint motion measurements.

U.S. Pat. No. 5,505,208 to Toomin et al. developed a method formeasuring muscle dysfunction by means of collecting muscle activitymeasurements using electrodes in a pattern across a subject's back whilehaving the subject perform a series of poses where measurements are madeat static periods within the movement. These electromyographicalreadings of “unhealthy” subjects were then compared to those of a“normal” population so as to be able to identify those subjects withabnormal readings, however does not provide for a method to report theresults as a degree of departure from an ideal reading, instead can onlysay whether the reading is “abnormal”. U.S. Pat. No. 6,280,395 added anadditional advantage to this method for determining muscle dysfunctionby using the same method, yet adding the ability to better normalize thedata by employing a more accurate reading of the thickness of theadipose tissue and other general characteristics that might introducevariability into the readings, as well as the ability to quantify howabnormal a subject's electromyographical reading is as compared to a“normal” population.

Joint muscle activity has been evaluated using electromyography incombination with some type method or device to track the surface motionof the joint. In one study, visual landmarks were used to help thesubject more consistently reproduce a tested motion so as to standardizethe joint motion and eliminate variability. (Lariviere, C 2000) However,visual land marking methods to not yield as “standardized” a motion ascan be achieved with motion that is mechanically controlled, andmeasurements of the motion of internal joint structures based on surfacemotion measurements are too variable to be of significant clinicalutility.

Another study used electromyography in conjunction with the use of agoniometer, a device that measures the surface motion of external bodyparts so as to link the muscle activity signals with precise surfacemotion measurements. (Kaigle et al. (1998) Journal of Spinal Disorders11(2): 163-174). This method however does not take into considerationthe motion of internal joint structures such that a determination as tothe specific cause of j oint dysfunction cannot be evaluated.

Electromyographic measurements taken during weight-bearing joint motion,with simultaneous recording of the motion of the body part usinggoniometers and also with simultaneous recordings of the motion ofinternal joint structures through the tracking of surgically-implantedmetal markers, has been used to correlate muscle activity with themotion of joints and internal joint structures (Kaigle, supra). Howeverthis approach studied joint motion that was uncontrolled and required aninvasive surgical procedure to place the metal markers, and thus wereneither useful nor feasible for clinical diagnostic application.

Electromyography has also been used in conjunction with a device thatprovides transient force perturbation so as to observe whether there isa difference between subjects with low back pain and those without lowback pain to determine how their muscles respond to such a force.(Stokes, Fox et al. 2006) The objective was to determine whether thereis an altered muscle activation pattern when using a ramped effort. Thisapproach however does not address the issue of which discrete musclegroup or groups might account for the difference between activationpatterns in subjects with joint dysfunctions and those without.Furthermore, this method does not take into consideration the internalstructural joint motions and thus provides an incomplete set ofinformation upon which to draw diagnostic conclusions.

SUMMARY OF THE INVENTION

An imaging system that comprises a tracking system and an imaging systemthat communicate information through real-time or near real-timefeedback loops and applies continuous adjustments to the imagingenvironment during an imaging session based upon the importedinformation from the tracking system. The feedback can be configurableto dynamically change to adjust the range of motion to correspond to anachieved patient motion instead of a motion of the patient movementdevice.

The integrated imaging system integrates a hardware and softwarecomponent and incorporates a tracking system for producing precisediagnostic information and image information for the purposes ofproducing an optimal imaging session, and an imaging apparatus withcentral control unit that communicates with each component andcontinuously adjusts so as to produce an most favorable imagingenvironment.

The integrated imaging system can be adapted and configured to importinformation about the testing session and adapt functional imagingsettings based on the imported information. Those skilled in the artwill appreciate that the system described herein can be applied orincorporated into any imaging device available now and what will beavailable in the future.

The imaging system integrates a series of feedback loops that shareinformation with respect to patient positioning and imaging quality andfrequency. The information can be transmitted through either a directwire-based electronic connection between the two or more components, orthrough a wireless connection. The information can be the type that isderived from computer programming or from operator or patient input, orfrom a combination of computer programmed information plus operatorand/or patient input.

Methods, systems and devices register and track imaging informationreal-time or near real-time and provide a feedback mechanism whichimpacts further imaging. As a result of the feedback, patient exposureduring imaging may be reduced and image capture may be enhanced.

An aspect of the disclosure is directed to a machine-readable mediumthat provides instructions which, when executed by a set of processors,causes the processors to provide instructions to at least one of amotion device and an imaging device comprising: receiving informationfrom at least one of the motion device and the imaging device during animaging session; analyzing the received information; instructing atleast one of the motion device and imaging device to change the imagingenvironment during the imaging session. In at least some aspects, thesteps of receiving, analyzing and instructing are repeated a pluralityof times during the imaging session. In other aspects, the step ofinstructing is performed real-time or near real-time. Real-time can, forexample be performed such that the analysis calculates the data quicklyenough such that no data are excluded from the analysis. Additionally,real-time can be configured to received data, process it and respondwithin a time frame set by outside events and in such a manner so thatno delay is perceived by an operator or patient. Near real-time mightinclude, for example a momentary lag time (seconds to minutes) within animaging session while the information is processed and instructions aregenerated. The instruction can change an aspect of an imaging fieldand/or change a movement of a motion device. Suitable imaging devicesinclude, but are not limited to, for example an X-ray tube and imageintensifier with dosage control, a magnetic resonance scanner.Additionally, a suitable motion device can be configured to furthercomprise a laterally moveable platform, such as a movable platform issituated on a support which lies on an upper surface of the platformbase. The machine-readable medium can further comprise a processingsystem. In at least some aspects the motion device is adapted tocommunicate motion information to the imaging device during use.Moreover, continuous adjustments can be made to an imaging environment,including, for example, changes to a range of motion of the motiondevice is based on a selected target motion for a patient, such as arange of motion of the device is based on a gross motion of a patient.

Another aspect of the disclosure is directed to an apparatus for use ina shared computer network being able to carry real-time data streams theapparatus comprising: means for transmitting data packages to a datadestination in at least one real-time or near real-time data stream overthe shared computer network, wherein each of the data packets containsinstructions for controlling at least one of an imaging device and amotion control device during an imaging session. Instructions can bestreamed over the shared computer network a plurality of times duringthe imaging session. Additionally, instruction can be configured tochange an aspect of an imaging field and/or movement of a motion device.Suitable imaging devices include, but are not limited to, an X-ray tubeand image intensifier with dosage control and a magnetic resonancescanner. Additionally, the motion device can further comprises alaterally moveable platform, such as a movable platform is situated on asupport which lies on an upper surface of the platform base. A controlarm can further be provided for driving movement of a moveable platform.Moreover, a processing system can be provided. The motion device canfurther be adapted to communicate motion information to the imagingdevice during use. Furthermore continuous adjustments are made to animaging environment. A range of motion of the motion device can furtherbe based on a selected target motion for a patient, or on a gross motionof a patient.

Still another aspect of the disclosure is directed to a system measuringskeletal joint motion in a subject comprising: a) a motion deviceadapted and configured to continuously move a joint of the subject, themotion device comprising: a platform base, and a motion platform furthercomprising a static platform connected to an upper surface of theplatform base, a movable platform connected to at least one of thestatic platform or an upper surface of the platform base, wherein thestatic platform is adjacent the movable platform wherein movement of themovable platform is achieved in operation by a motor in communicationwith the moveable platform; b) an imaging device in communication withthe motion device adapted and configured to obtain imaging data; and c)a computing system adapted and configured to analyze the obtainedimaging data to generate an instruction and then communicate theinstruction to at least one of the motion device and the imaging device.Suitable imaging devices include, but are not limited to an X-ray tubeand image intensifier with dosage control and a magnetic resonancescanner. Additionally, the platform can, for example, be a laterallymoveable platform, such as a platform situated on a support which lieson the upper surface of the platform base. Additionally, a control armcan be provided for driving movement of the moveable platform. Moreovera processing system can be provided. The motion device can be adapted tocommunicate motion information to the imaging device during use. Thesystem can also provide continuous adjustments to the imagingenvironment. Suitable instruction include, for example, changes anaspect of an imaging field and/or changes to a movement of a motiondevice. The range of motion of the motion device is based on a selectedtarget motion for a patient. Moreover, the range of motion of the deviceis based on a gross motion of a patient.

Another aspect of the disclosure is directed to a method for imagingskeletal structures in vivo comprising: i) positioning a subject on amotion device adapted and configured to move a joint during a usesession; ii) imaging the subject positioned on the motion device duringthe use session with an imaging device; iii) collecting image data; iv)analyzing the collected image data; and v) communicating an instructionbased on the analyzed image data to at least one of the motion deviceand imaging device prior to acquiring a subsequent image. The step ofcommunicating an instruction can, for example, include changing anaspect of an imaging field and/or changing a movement of a motiondevice. As will be appreciated by those skilled in the art, the step ofcommunicating an instruction can include, for example, transmitting anew instruction which changes one or more settings, transmitting aninstruction which maintains the most recent one or more settings,transmitting an instruction that repeats an earlier one or moreinstructions, or providing no change in instruction in currentinstructions. Where no change instructions are provided, the system canbe adapted and configured to automatically repeat the most recentinstructions after a lag of a set amount of time from providing theimage data for analysis. Additionally, suitable imaging devices include,but are not limited to an X-ray tube and image intensifier with dosagecontrol and a magnetic resonance scanner. Additionally, the motiondevice can further comprises a movable platform situated on a supportwhich lies on an upper surface of a platform base. In some cases acalibration step is carried out prior to at least one of the methodsteps of i) to vi). Additionally, the relative motion of lumbarvertebrae L3 to L3, L3 to L4 and L4 to L5 can be tracked simultaneouslyor separately and/or the relative motion of lumbar vertebrae L3 to L3,L3 to L4 and L4 to L5 are tracked simultaneously or separately.Moreover, the method can be used for a diagnosis of a pseudoarthrosis inthe subject, and the method comprising analyzing the relative motion ofskeletal structures in the subject. An additional step can be providedfor presenting an output in graphical form.

Yet another aspect of the disclosure includes a process for capturingdata and controlling skeletal joint motion of a subject comprising: (a)providing an apparatus adapted and configured to selectively cause andcontrol joint motion of the subject having a base positioned in a firstbase plane, a fixable platform adapted and configured to engage the baseat an attachment mechanism, the fixable platform having a first positionin a first fixable platform plane and fixably adjustable to a secondposition, a dynamic platform having a first position in a first dynamicplatform plane, adjustable to a second position and selectivelyrotatable about an axis, and a coupling member adapted and configured toconnect the fixable platform to the dynamic platform or the base; (b)positioning the subject in a first position such that a first body partof the subject is at least partially positioned adjacent the staticplatform, and a second body part of the subject is at least partiallypositioned adjacent the motion platform; (c) capturing, with a medicaldiagnostic device, a first diagnostic data from the subject and theapparatus; (d) transmitting the first diagnostic data from the subjectto a machine-readable medium; (e) analyzing the first diagnostic data;(f) generating an instructions from the analyzed first diagnostic data;(g) transmitting the instruction to the apparatus; (h) repositioning theapparatus such that the subject is placed in a second position differentfrom the first position; and (i) capturing, with the medical diagnosticdevice, second diagnostic data from the subject and the apparatus in thesecond position. The data capturing steps of the process can furthercomprise using a medical diagnostic device selected from the groupconsisting of X-ray scanner, X-ray tube with image intensifier tube,magnetic resonance scanner, infrared camera, computed tomographyscanner, ultrasound scanner, electromyography sensor unit, digitalcamera and camera. Moreover, steps (b) through (i) can be repeated aplurality of times during a single imaging session. Instructions can beprovided that change an aspect of an imaging field and/or change amovement of a motion device.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1A is a diagram showing a representative example of a logic devicethrough which an imaging system can provide real-time or near real-timefeedback information with respect to patient position to applyadjustments to the imaging environment to optimize imaging and dataacquisition;

FIG. 1B is a block diagram of an exemplary computing environment throughwhich an imaging system can provide real-time or near real-time feedbackinformation with respect to patient position to apply adjustments to theimaging environment to optimize imaging and data acquisition;

FIG. 1C is an illustrative architectural diagram showing some structurethat can be employed by devices through which an imaging system canprovide real-time or near real-time feedback information with respect topatient position to apply adjustments to the imaging environment tooptimize imaging and data acquisition;

FIG. 2 is an exemplary diagram of a server in an implementation suitablefor use in a system where an imaging system can provide real-time ornear real-time feedback information with respect to patient position toapply adjustments to the imaging environment to optimize imaging anddata acquisition;

FIG. 3 is an exemplary diagram of a master system in an implementationsuitable for use in a system where an imaging system can providereal-time or near real-time feedback information with respect to patientposition to apply adjustments to the imaging environment to optimizeimaging and data acquisition;

FIG. 4 is a block diagram showing the cooperation of exemplarycomponents of a system suitable for use in a system where an imagingsystem can provide real-time or near real-time feedback information withrespect to patient position to apply adjustments to the imagingenvironment to optimize imaging and data acquisition;

FIGS. 5A and 5B show side and top view block diagrams of thehorizontally configured motion control device consisting of the twosub-systems and attachment mechanisms of the preferred embodiment of thehorizontally configured motion control device in a “default”configuration, according to one embodiment of the present invention;FIGS. 5C-E illustrate a device from different views;

FIGS. 6A and 6B show side view block diagrams of the horizontallyconfigured motion control device and related parts of the preferredembodiment in the “front-up” (FIG. 5A) and “front-down” (FIG. 5B)configurations suitable for use with the system disclosed;

FIGS. 7A and 7B show side and front view block diagrams, respectively, avertically configured motion control device in a “default” configurationsuitable for use with the system disclosed; FIGS. 7C-E illustrate adevice from different views;

FIGS. 8A, 8B, and 8C show side view diagrams of a vertically configuredmotion control device in a “default”, “top out” and “top in”configurations, respectively, according to one embodiment of the presentinvention;

FIG. 9A is a simplified block diagram of the components comprising theintegrated imaging system where the imaging apparatus and the trackingapparatus are integrated into the same apparatus and the centralprocessing unit is a part of the apparatus;

FIG. 9B is a simplified block diagram of the components comprising theintegrated imaging system where the imaging apparatus and the trackingapparatus are integrated into the same apparatus and the centralprocessing unit is a separate unit that communicates either wirelesslyor through a direct wired connection with the integrated imaging system;

FIG. 10 is a simplified block diagram of the components comprising theintegrated imaging system where the imaging apparatus and the trackingapparatus are two separate units and communicate through a centralprocessing unit that communicates with each the imaging and trackingapparatus through a wireless or a direct wired connection; and

FIG. 11 is a flow chart of the process by which the integrated imagingsystem operates.

DETAILED DESCRIPTION OF THE INVENTION

An integrated imaging system that incorporates real time trackingalgorithms and feedback loops for producing precise diagnosticinformation, and an imaging device that is adaptable in response to theintegrated imaging system and feedback loops to produce an optimalimaging session.

I. COMPUTING SYSTEMS

The systems and methods described herein rely on a variety of computersystems, networks and/or digital devices for operation. In order tofully appreciate how the system operates an understanding of suitablecomputing systems is useful. The systems and methods disclosed hereinare enabled as a result of application via a suitable computing system.

FIG. 1A is a block diagram showing a representative example logic devicethrough which a browser can be accessed to implement the presentinvention. A computer system (or digital device) 100, which may beunderstood as a logic apparatus adapted and configured to readinstructions from media 114 and/or network port 106, is connectable to aserver 110, and has a fixed media 116. The computer system 100 can alsobe connected to the Internet or an intranet. The system includes centralprocessing unit (CPU) 102, disk drives 104, optional input devices,illustrated as keyboard 118 and/or mouse 120 and optional monitor 108.Data communication can be achieved through, for example, communicationmedium 109 to a server 110 at a local or a remote location. Thecommunication medium 109 can include any suitable means of transmittingand/or receiving data. For example, the communication medium can be anetwork connection, a wireless connection or an internet connection. Itis envisioned that data relating to the present invention can betransmitted over such networks or connections. The computer system canbe adapted to communicate with a participant and/or a device used by aparticipant. The computer system is adaptable to communicate with othercomputers over the Internet, or with computers via a server.

FIG. 1B depicts another exemplary computing system 100. The computingsystem 100 is capable of executing a variety of computing applications138, including computing applications, a computing applet, a computingprogram, or other instructions for operating on computing system 100 toperform at least one function, operation, and/or procedure. Computingsystem 100 is controllable by computer readable storage media fortangibly storing computer readable instructions, which may be in theform of software. The computer readable storage media adapted totangibly store computer readable instructions can contain instructionsfor computing system 100 for storing and accessing the computer readablestorage media to read the instructions stored thereon themselves. Suchsoftware may be executed within CPU 102 to cause the computing system100 to perform desired functions. In many known computer servers,workstations and personal computers CPU 102 is implemented bymicro-electronic chips CPUs called microprocessors. Optionally, aco-processor, distinct from the main CPU 102, can be provided thatperforms additional functions or assists the CPU 102. The CPU 102 may beconnected to co-processor through an interconnect. One common type ofcoprocessor is the floating-point coprocessor, also called a numeric ormath coprocessor, which is designed to perform numeric calculationsfaster and better than the general-purpose CPU 102.

As will be appreciated by those skilled in the art, a computer readablemedium stores computer data, which data can include computer programcode that is executable by a computer, in machine readable form. By wayof example, and not limitation, a computer readable medium may comprisecomputer readable storage media, for tangible or fixed storage of data,or communication media for transient interpretation of code-containingsignals. Computer readable storage media, as used herein, refers tophysical or tangible storage (as opposed to signals) and includeswithout limitation volatile and non-volatile, removable andnon-removable storage media implemented in any method or technology forthe tangible storage of information such as computer-readableinstructions, data structures, program modules or other data. Computerreadable storage media includes, but is not limited to, RAM, ROM, EPROM,EEPROM, flash memory or other solid state memory technology, CD-ROM,DVD, or other optical storage, magnetic cassettes, magnetic tape,magnetic disk storage or other magnetic storage devices, or any otherphysical or material medium which can be used to tangibly store thedesired information or data or instructions and which can be accessed bya computer or processor

In operation, the CPU 102 fetches, decodes, and executes instructions,and transfers information to and from other resources via the computer'smain data-transfer path, system bus 140. Such a system bus connects thecomponents in the computing system 100 and defines the medium for dataexchange. Memory devices coupled to the system bus 140 include randomaccess memory (RAM) 124 and read only memory (ROM) 126. Such memoriesinclude circuitry that allows information to be stored and retrieved.The ROMs 126 generally contain stored data that cannot be modified. Datastored in the RAM 124 can be read or changed by CPU 102 or otherhardware devices. Access to the RAM 124 and/or ROM 126 may be controlledby memory controller 122. The memory controller 122 may provide anaddress translation function that translates virtual addresses intophysical addresses as instructions are executed.

In addition, the computing system 100 can contain peripherals controller128 responsible for communicating instructions from the CPU 102 toperipherals, such as, printer 142, keyboard 118, mouse 120, and datastorage drive 143. Display 108, which is controlled by a displaycontroller 163, is used to display visual output generated by thecomputing system 100. Such visual output may include text, graphics,animated graphics, and video. The display controller 134 includeselectronic components required to generate a video signal that is sentto display 108. Further, the computing system 100 can contain networkadaptor 136 which may be used to connect the computing system 100 to anexternal communications network 132.

II. NETWORKS AND INTERNET PROTOCOL

As is well understood by those skilled in the art, the Internet is aworldwide network of computer networks. Today, the Internet is a publicand self-sustaining network that is available to many millions of users.The Internet uses a set of communication protocols called TCP/IP (i.e.,Transmission Control Protocol/Internet Protocol) to connect hosts. TheInternet has a communications infrastructure known as the Internetbackbone. Access to the Internet backbone is largely controlled byInternet Service Providers (ISPs) that resell access to corporations andindividuals.

The Internet Protocol (IP) enables data to be sent from one device(e.g., a phone, a Personal Digital Assistant (PDA), a computer, etc.) toanother device on a network. There are a variety of versions of IPtoday, including, e.g., IPv4, IPv6, etc. Other IPs are no doubtavailable and will continue to become available in the future, any ofwhich can be used without departing from the scope of the invention.Each host device on the network has at least one IP address that is itsown unique identifier and acts as a connectionless protocol. Theconnection between end points during a communication is not continuous.When a user sends or receives data or messages, the data or messages aredivided into components known as packets. Every packet is treated as anindependent unit of data and routed to its final destination—but notnecessarily via the same path.

The Open System Interconnection (OSI) model was established tostandardize transmission between points over the Internet or othernetworks. The OSI model separates the communications processes betweentwo points in a network into seven stacked layers, with each layeradding its own set of functions. Each device handles a message so thatthere is a downward flow through each layer at a sending end point andan upward flow through the layers at a receiving end point. Theprogramming and/or hardware that provides the seven layers of functionis typically a combination of device operating systems, applicationsoftware, TCP/IP and/or other transport and network protocols, and othersoftware and hardware.

Typically, the top four layers are used when a message passes from or toa user and the bottom three layers are used when a message passesthrough a device (e.g., an IP host device). An IP host is any device onthe network that is capable of transmitting and receiving IP packets,such as a server, a router or a workstation. Messages destined for someother host are not passed up to the upper layers but are forwarded tothe other host. The layers of the OSI model are listed below. Layer 7(i.e., the application layer) is a layer at which, e.g., communicationpartners are identified, quality of service is identified, userauthentication and privacy are considered, constraints on data syntaxare identified, etc. Layer 6 (i.e., the presentation layer) is a layerthat, e.g., converts incoming and outgoing data from one presentationformat to another, etc. Layer 5 (i.e., the session layer) is a layerthat, e.g., sets up, coordinates, and terminates conversations,exchanges and dialogs between the applications, etc. Layer-4 (i.e., thetransport layer) is a layer that, e.g., manages end-to-end control anderror-checking, etc. Layer-3 (i.e., the network layer) is a layer that,e.g., handles routing and forwarding, etc. Layer-2 (i.e., the data-linklayer) is a layer that, e.g., provides synchronization for the physicallevel, does bit-stuffing and furnishes transmission protocol knowledgeand management, etc. The Institute of Electrical and ElectronicsEngineers (IEEE) sub-divides the data-link layer into two furthersub-layers, the MAC (Media Access Control) layer that controls the datatransfer to and from the physical layer and the LLC (Logical LinkControl) layer that interfaces with the network layer and interpretscommands and performs error recovery. Layer 1 (i.e., the physical layer)is a layer that, e.g., conveys the bit stream through the network at thephysical level. The IEEE sub-divides the physical layer into the PLCP(Physical Layer Convergence Procedure) sub-layer and the PMD (PhysicalMedium Dependent) sub-layer.

III. WIRELESS NETWORKS

Wireless networks can incorporate a variety of types of mobile devices,such as, e.g., cellular and wireless telephones, PCs (personalcomputers), laptop computers, wearable computers, cordless phones,pagers, headsets, printers, PDAs, etc. For example, mobile devices mayinclude digital systems to secure fast wireless transmissions of voiceand/or data. Typical mobile devices include some or all of the followingcomponents: a transceiver (for example a transmitter and a receiver,including a single chip transceiver with an integrated transmitter,receiver and, if desired, other functions); an antenna; a processor;display; one or more audio transducers (for example, a speaker or amicrophone as in devices for audio communications); electromagnetic datastorage (such as ROM, RAM, digital data storage, etc., such as indevices where data processing is provided); memory; flash memory; and/ora full chip set or integrated circuit; interfaces (such as universalserial bus (USB), coder-decoder (CODEC), universal asynchronousreceiver-transmitter (UART), phase-change memory (PCM), etc.). Othercomponents can be provided without departing from the scope of theinvention.

Wireless LANs (WLANs) in which a mobile user can connect to a local areanetwork (LAN) through a wireless connection may be employed for wirelesscommunications. Wireless communications can include communications thatpropagate via electromagnetic waves, such as light, infrared, radio, andmicrowave. There are a variety of WLAN standards that currently exist,such as Bluetooth®, IEEE 802.11, and the obsolete HomeRF.

By way of example, Bluetooth products may be used to provide linksbetween mobile computers, mobile phones, portable handheld devices,personal digital assistants (PDAs), and other mobile devices andconnectivity to the Internet. Bluetooth is a computing andtelecommunications industry specification that details how mobiledevices can easily interconnect with each other and with non-mobiledevices using a short-range wireless connection. Bluetooth creates adigital wireless protocol to address end-user problems arising from theproliferation of various mobile devices that need to keep datasynchronized and consistent from one device to another, thereby allowingequipment from different vendors to work seamlessly together.

An IEEE standard, IEEE 802.11, specifies technologies for wireless LANsand devices. Using 802.11, wireless networking may be accomplished witheach single base station supporting several devices. In some examples,devices may come pre-equipped with wireless hardware or a user mayinstall a separate piece of hardware, such as a card, that may includean antenna. By way of example, devices used in 802.11 typically includethree notable elements, whether or not the device is an access point(AP), a mobile station (STA), a bridge, a personal computing memory cardInternational Association (PCMCIA) card (or PC card) or another device:a radio transceiver; an antenna; and a MAC (Media Access Control) layerthat controls packet flow between points in a network.

In addition, Multiple Interface Devices (MIDs) may be utilized in somewireless networks. MIDs may contain two independent network interfaces,such as a Bluetooth interface and an 802.11 interface, thus allowing theMID to participate on two separate networks as well as to interface withBluetooth devices. The MID may have an IP address and a common IP(network) name associated with the IP address.

Wireless network devices may include, but are not limited to Bluetoothdevices, WiMAX (Worldwide Interoperability for Microwave Access),Multiple Interface Devices (MIDs), 802.11x devices (IEEE 802.11 devicesincluding, 802.11a, 802.11b and 802.11g devices), HomeRF (Home RadioFrequency) devices, Wi-Fi (Wireless Fidelity) devices, GPRS (GeneralPacket Radio Service) devices, 3 G cellular devices, 2.5 G cellulardevices, GSM (Global System for Mobile Communications) devices, EDGE(Enhanced Data for GSM Evolution) devices, TDMA type (Time DivisionMultiple Access) devices, or CDMA type (Code Division Multiple Access)devices, including CDMA2000. Each network device may contain addressesof varying types including but not limited to an IP address, a BluetoothDevice Address, a Bluetooth Common Name, a Bluetooth IP address, aBluetooth IP Common Name, an 802.11 IP Address, an 802.11 IP commonName, or an IEEE MAC address.

Wireless networks can also involve methods and protocols found in,Mobile IP (Internet Protocol) systems, in PCS systems, and in othermobile network systems. With respect to Mobile IP, this involves astandard communications protocol created by the Internet EngineeringTask Force (IETF). With Mobile IP, mobile device users can move acrossnetworks while maintaining their IP Address assigned once. See Requestfor Comments (RFC) 3344. NB: RFCs are formal documents of the InternetEngineering Task Force (IETF). Mobile IP enhances Internet Protocol (IP)and adds a mechanism to forward Internet traffic to mobile devices whenconnecting outside their home network. Mobile IP assigns each mobilenode a home address on its home network and a care-of-address (CoA) thatidentifies the current location of the device within a network and itssubnets. When a device is moved to a different network, it receives anew care-of address. A mobility agent on the home network can associateeach home address with its care-of address. The mobile node can send thehome agent a binding update each time it changes its care-of addressusing Internet Control Message Protocol (ICMP).

In basic IP routing (e.g., outside mobile IP), routing mechanisms relyon the assumptions that each network node always has a constantattachment point to the Internet and that each node's IP addressidentifies the network link it is attached to. In this document, theterminology “node” includes a connection point, which can include aredistribution point or an end point for data transmissions, and whichcan recognize, process and/or forward communications to other nodes. Forexample, Internet routers can look at an IP address prefix or the likeidentifying a device's network. Then, at a network level, routers canlook at a set of bits identifying a particular subnet. Then, at a subnetlevel, routers can look at a set of bits identifying a particulardevice. With typical mobile IP communications, if a user disconnects amobile device from the Internet and tries to reconnect it at a newsubnet, then the device has to be reconfigured with a new IP address, aproper netmask and a default router. Otherwise, routing protocols wouldnot be able to deliver the packets properly.

FIG. 1C depicts components that can be employed in system configurationsenabling the systems and technical effect of this invention, includingwireless access points to which client devices communicate. In thisregard, FIG. 1C shows a wireless network 150 connected to a wirelesslocal area network (WLAN) 152. The WLAN 152 includes an access point(AP) 154 and a number of user stations 156, 156′. For example, thenetwork 150 can include the Internet or a corporate data processingnetwork. The access point 154 can be a wireless router, and the userstations 156, 156′ can be portable computers, personal desk-topcomputers, PDAs, portable voice-over-IP telephones and/or other devices.The access point 154 has a network interface 158 linked to the network150, and a wireless transceiver in communication with the user stations156, 156′. For example, the wireless transceiver 160 can include anantenna 162 for radio or microwave frequency communication with the userstations 156, 156′. The access point 154 also has a processor 164, aprogram memory 166, and a random access memory 168. The user station 156has a wireless transceiver 170 including an antenna 172 forcommunication with the access point station 154. In a similar fashion,the user station 156′ has a wireless transceiver 170′ and an antenna 172for communication to the access point 154. By way of example, in someembodiments an authenticator could be employed within such an accesspoint (AP) and/or a supplicant or peer could be employed within a mobilenode or user station. Desktop 108 and key board 118 or input devices canalso be provided with the user status.

IV. MEDIA INDEPENDENT HANDOVER SERVICES

In IEEE P802.21/D.01.09, September 2006, entitled Draft IEEE Standardfor Local and Metropolitan Area Networks: Media Independent HandoverServices, among other things, the document specifies 802 mediaaccess-independent mechanisms that optimize handovers between 802systems and cellular systems. The IEEE 802.21 standard definesextensible media access independent mechanisms that enable theoptimization of handovers between heterogeneous 802 systems and mayfacilitate handovers between 802 systems and cellular systems. “Thescope of the IEEE 802.21 (Media Independent Handover) standard is todevelop a specification that provides link layer intelligence and otherrelated network information to upper layers to optimize handoversbetween heterogeneous media. This includes links specified by 3GPP,3GPP2 and both wired and wireless media in the IEEE 802 family ofstandards. Note, in this document, unless otherwise noted, “media”refers to method/mode of accessing a telecommunication system (e.g.cable, radio, satellite, etc.), as opposed to sensory aspects ofcommunication (e.g. audio, video, etc.).” See 1.1 of I.E.E.E.P802.21/D.01.09, September 2006, entitled Draft IEEE Standard for Localand Metropolitan Area Networks: Media Independent Handover Services, theentire contents of which document is incorporated herein into and aspart of this patent application. Other IEEE, or other such standards onprotocols can be relied on as appropriate or desirable.

FIG. 2 is an exemplary diagram of a server 210 in an implementationconsistent with the principles of the disclosure to achieve the desiredtechnical effect and transformation. Server 210 may include a bus 240, aprocessor 202, a local memory 244, one or more optional input units 246,one or more optional output units 248, a communication interface 232,and a memory interface 222. Bus 240 may include one or more conductorsthat permit communication among the components of chunk server 250.

Processor 202 may include any type of conventional processor ormicroprocessor that interprets and executes instructions. Local memory244 may include a random access memory (RAM) or another type of dynamicstorage device that stores information and instructions for execution byprocessor 202 and/or a read only memory (ROM) or another type of staticstorage device that stores static information and instructions for useby processor 202.

Input unit 246 may include one or more conventional mechanisms thatpermit an operator to input information to a server 110, such as akeyboard 118, a mouse 120 (shown in FIG. 1), a pen, voice recognitionand/or biometric mechanisms, etc. Output unit 248 may include one ormore conventional mechanisms that output information to the operator,such as a display 134, a printer 130 (shown in FIG. 1), a speaker, etc.Communication interface 232 may include any transceiver-like mechanismthat enables chunk server 250 to communicate with other devices and/orsystems. For example, communication interface 232 may include mechanismsfor communicating with master and clients.

Memory interface 222 may include a memory controller 122. Memoryinterface 222 may connect to one or more memory devices, such as one ormore local disks 274, and control the reading and writing of chunk datato/from local disks 276. Memory interface 222 may access chunk datausing a chunk handle and a byte range within that chunk.

FIG. 3 is an exemplary diagram of a master system 376 suitable for usein an implementation consistent with the principles of the disclosure toachieve the desired technical effect and transformation. Master system376 may include a bus 340, a processor 302, a main memory 344, a ROM326, a storage device 378, one or more input devices 346, one or moreoutput devices 348, and a communication interface 332. Bus 340 mayinclude one or more conductors that permit communication among thecomponents of master system 374.

Processor 302 may include any type of conventional processor ormicroprocessor that interprets and executes instructions. Main memory344 may include a RAM or another type of dynamic storage device thatstores information and instructions for execution by processor 302. ROM326 may include a conventional ROM device or another type of staticstorage device that stores static information and instructions for useby processor 302. Storage device 378 may include a magnetic and/oroptical recording medium and its corresponding drive. For example,storage device 378 may include one or more local disks that providepersistent storage.

Input devices 346 used to achieve the desired technical effect andtransformation may include one or more conventional mechanisms thatpermit an operator to input information to the master system 374, suchas a keyboard 118, a mouse 120, (shown in FIG. 1) a pen, voicerecognition and/or biometric mechanisms, etc. Output devices 348 mayinclude one or more conventional mechanisms that output information tothe operator, including a display 108, a printer 142 (shown in FIG. 1),a speaker, etc. Communication interface 332 may include anytransceiver-like mechanism that enables master system 374 to communicatewith other devices and/or systems. For example, communication interface332 may include mechanisms for communicating with servers and clients asshown above.

Master system 376 used to achieve the desired technical effect andtransformation may maintain file system metadata within one or morecomputer readable mediums, such as main memory 344 and/or storagedevice.

The computer implemented system provides a storage and delivery basewhich allows users to exchange services and information openly on theInternet used to achieve the desired technical effect andtransformation. A user will be enabled to operate as both a consumer andproducer of any and all digital content or information through one ormore master system servers.

A user executes a browser to view digital content items and can connectto the front end server via a network, which is typically the Internet,but can also be any network, including but not limited to anycombination of a LAN, a MAN, a WAN, a mobile, wired or wireless network,a private network, or a virtual private network. As will be understood avery large numbers (e.g., millions) of users are supported and can be incommunication with the website at any time. The user may include avariety of different computing devices. Examples of user devicesinclude, but are not limited to, personal computers, digital assistants,personal digital assistants, cellular phones, mobile phones, smartphones or laptop computers.

The browser can include any application that allows users to access webpages on the World Wide Web. Suitable applications include, but are notlimited to, Microsoft Internet Explorer®, Netscape Navigator®, Mozilla®Firefox, Apple® Safari or any application adapted to allow access to webpages on the World Wide Web. The browser can also include a video player(e.g., Flash™ from Adobe Systems, Inc.), or any other player adapted forthe video file formats used in the video hosting website. Alternatively,videos can be accessed by a standalone program separate from thebrowser. A user can access a video from the website by, for example,browsing a catalog of digital content, conducting searches on keywords,reviewing aggregate lists from other users or the system administrator(e.g., collections of videos forming channels), or viewing digitalcontent associated with particular user groups (e.g., communities).

V. COMPUTER NETWORK ENVIRONMENT

Computing system 100, described above, can be deployed as part of acomputer network used to achieve the desired technical effect andtransformation. In general, the above description for computingenvironments applies to both server computers and client computersdeployed in a network environment. FIG. 4 illustrates an exemplaryillustrative networked computing environment 400, with a server incommunication with client computers via a communications network 450. Asshown in FIG. 4, server 410 may be interconnected via a communicationsnetwork 450 (which may be either of, or a combination of a fixed-wire orwireless LAN, WAN, intranet, extranet, peer-to-peer network, virtualprivate network, the Internet, or other communications network) with anumber of client computing environments such as tablet personal computer402, mobile telephone 404, telephone 406, personal computer 402, andpersonal digital assistant 408. In a network environment in which thecommunications network 450 is the Internet, for example, server 410 canbe dedicated computing environment servers operable to process andcommunicate data to and from client computing environments via any of anumber of known protocols, such as, hypertext transfer protocol (HTTP),file transfer protocol (FTP), simple object access protocol (SOAP), orwireless application protocol (WAP). Other wireless protocols can beused without departing from the scope of the disclosure, including, forexample Wireless Markup Language (WML), DoCoMo i-mode (used, forexample, in Japan) and XHTML Basic. Additionally, networked computingenvironment 400 can utilize various data security protocols such assecured socket layer (SSL) or pretty good privacy (PGP). Each clientcomputing environment can be equipped with operating system 438 operableto support one or more computing applications, such as a web browser(not shown), or other graphical user interface (not shown), or a mobiledesktop environment (not shown) to gain access to server computingenvironment 400.

In operation, a user (not shown) may interact with a computingapplication running on a client computing environment to obtain desireddata and/or computing applications. The data and/or computingapplications may be stored on server computing environment 400 andcommunicated to cooperating users through client computing environmentsover exemplary communications network 450. The computing applications,described in more detail below, are used to achieve the desiredtechnical effect and transformation set forth. A participating user mayrequest access to specific data and applications housed in whole or inpart on server computing environment 400. These data may be communicatedbetween client computing environments and server computing environmentsfor processing and storage. Server computing environment 400 may hostcomputing applications, processes and applets for the generation,authentication, encryption, and communication data and applications andmay cooperate with other server computing environments (not shown),third party service providers (not shown), network attached storage(NAS) and storage area networks (SAN) to realize application/datatransactions.

The communication network is adaptable and configurable to be incommunication with one or more input devices 446 and/or one or moreoutput devices 448 as discussed above. In general input devices arethose devices or components that provide information to the system andoutput devices are those devices or components that provide informationfrom the system. As will be appreciated by those skilled in the device asingle device can, at times, be capable of operating as both an inputdevice and an output device. For purposes of appreciating the context ofthe disclosure, suitable input devices are, for example, those devicesthat input information into the system such as imaging devices and/orpatient motion control devices as discussed herein. Suitable outputdevices are, for example, those devices that receive information and/ordata from one or more input devices, in a computing environment (such asshown in FIG. 4), process the received information and/or data, andgenerate a return real-time or near real-time signal to the inputdevices to achieve a technical effect of controlling the behavior orperformance of the input devices to achieve a desired

VI. Media Independent Information Service

The Media Independent Information Service (MIIS) provides a frameworkand corresponding mechanisms by which an MIHF entity may discover andobtain network information existing within a geographical area tofacilitate handovers. Additionally or alternatively, neighboring networkinformation discovered and obtained by this framework and mechanisms canalso be used in conjunction with user and network operator policies foroptimum initial network selection and access (attachment), or networkre-selection in idle mode. MIIS primarily provides a set of informationelements (IEs), the information structure and its representation, and aquery/response type of mechanism for information transfer. Theinformation can be present in some information server from which, e.g.,an MIHF in the Mobile Node (MN) can access it.

Depending on the type of mobility, support for different types ofinformation elements may be necessary for performing handovers. MIISprovides the capability for obtaining information about lower layerssuch as neighbor maps and other link layer parameters, as well asinformation about available higher layer services such as Internetconnectivity.

MIIS provides a generic mechanism to allow a service provider and amobile user to exchange information on different handover candidateaccess networks. The handover candidate information can includedifferent access technologies such as IEEE 802 networks, 3GPP networksand 3GPP2 networks. The MIIS also allows this collective information tobe accessed from any single network. For example, by using an IEEE802.11 access network, it can be possible to get information not onlyabout all other IEEE 802 based networks in a particular region but alsoabout 3GPP and 3GPP2 networks. Similarly, using, e.g., a 3GPP2interface, it can be possible to get access to information about allIEEE 802 and 3GPP networks in a given region. This capability allows theMN to use its currently active access network and inquire about otheravailable access networks in a geographical region. Thus, a MN is freedfrom the burden of powering up each of its individual radios andestablishing network connectivity for the purpose of retrievingheterogeneous network information. MIIS enables this functionalityacross all available access networks by providing a uniform way toretrieve heterogeneous network information in any geographical area.

VII. DEVICES

Motion control device can be is represented by a large box that containsvarious subsystems. Suitable motion control devices can either bepassive or active. As will be appreciated by those of skill in the art,the motion control device, can also be a horizontally configured motioncontrol device, a vertically configured motion control device or abutterfly configured device. Motion control devices suitable for usewith the systems include any of the motion control devices describedherein as well as any other device suitable for controlling the motionof a target patient anatomy.

The diagnostic imaging hardware contains a field of imaging, which is aphysical space in which objects imaged by the hardware must be locatedduring the imaging process to produce images. The field of imaging cancontain a posture assistance device such as a table, bed, chair, orother device intended to bear all or some of the subject's weight and toprovide physical support to a specific type of posture. Alternatively,the field of imaging can contain no such devices if the subject can besituated directly onto the floor and/or the motion control device anddoes not require the use of an additional device to bear weight and/orsupport specific postures, according to one embodiment of the presentinvention. The motion control device, or sub-systems therein, occupypart or the entire field of imaging and is physically connected andsupported either by resting on the floor itself, or by being physicallyand immovably attached to the imaging equipment or a posture-assistancedevices within the field of imaging. All parts of the horizontallyconfigured motion control device that are located within the field ofimaging are constructed of materials that are either radiolucent in thecase of use with videoflouroscopic and moving CT imaging systems, oralternatively compatible with MRI images in the case of a moving MRIimaging system, and therefore these parts of the motion control devicedo not obscure or produce artifacts on the diagnostic images. The motioncontrol device may also have the capacity to have pillows, cushions,and/or restraining devices attached to it at points where these pillows,cushions, and/or restraining devices aid in improving the comfort of thesubject and/or in producing the correct posture and/or motion requiredfor the test. The motion control device as a unit is attachable anddetachable by the operator within the field of imaging, according to oneembodiment of the present invention.

A base is provided for the purpose of physically and immovably fixingand stabilizing the motion control device within the field of imaging toeither the floor, the imaging equipment, and/or a posture-assistancedevice while the images and other measurements are being collected, andalso for the purpose of providing an immoveable fixed structure on whichto attach other sub-systems of the motion control device. The baseconnects via attachment mechanisms at the points of contact between thebase and either the floor, the imaging equipment, and/or aposture-assistance device.

As the motion control device physically attaches to and therefore maybear its weight onto the base, and as the motion control device can beconfigured to also bear the entire weight of the subject, and with thesubject moving during the testing process and therefore producing bothstatic and dynamic forces, the base needs the structural integrity andgripping force required to remain static, stable, and fixed in thepresence of such loads and forces. The structural integrity is affordedby the use of rigid and strong materials such as plastics whenradiolucent materials are desirable and in situations wherecompatibility with dynamic MRI systems is required, according to oneembodiment of the present invention. Said gripping force is afforded bythe use of strong fixation mechanisms at the points of contact, and maybe accomplished by either: (1) the weight of the motion control deviceitself, and the friction caused thereby and enhanced by the use ofhigh-friction materials such as rubber at the points of contact, to fixand stabilize the motion control device; (2) screws, clamps, bolts,fasteners, straps, ties, cuffs, nuts, pins, or any other rigid orflexible fixation mechanism that provides immoveable fixation at thepoints of contact; and/or (3) some combination therein.

Base can be a highly configurable sub-system, adapted and configured tohave several configurations and versions to accommodate the differenttypes of postures; different types, sizes, and configurations ofposture-assistance devices; different sizes and geometries of imagingequipment and imaging fields; different materials at the point ofcontact to which to connect between the base and either the floor, theimaging equipment, and/or a posture-assistance device; and differentgeometries and sizes of these points of contact.

As applied to a butterfly motion control device, the diagnostic imaginghardware contains a field of imaging, which is a physical space in whichobjects imaged by the hardware must be located during the imagingprocess to produce images. The field of imaging can contain a postureassistance device such as a table, bed, chair, or other device intendedto bear all or some of the subject's weight and to provide physicalsupport to a specific type of posture. Alternatively, the field ofimaging can contain no such devices if the subject can be situateddirectly onto the floor and/or the motion control device and does notrequire the use of an additional device to bear weight and/or supportspecific postures. The “butterfly” motion control device, or sub-systemstherein, occupy part or the entire field of imaging and is physicallyconnected and supported either by resting on the floor itself, or bybeing physically and immovably attached to the imaging equipment or toone of the above-mentioned posture-assistance devices within the fieldof imaging. All parts of the “butterfly” motion control device that arelocated within the field of imaging are constructed of materials thatare either radiolucent in the case of use with videoflouroscopic andmoving CT imaging systems, or alternatively compatible with on MM imagesin the case of a moving MRI imaging system, and therefore these parts ofthe “butterfly” motion control device do not obscure or produceartifacts on the diagnostic images. The “butterfly” motion controldevice also has the capacity to have pillows, cushions, and/orrestraining devices attached to it at points where these pillows,cushions, and/or restraining devices aid in improving the comfort of thesubject and/or in producing the correct posture and/or motion requiredfor the test. The “butterfly” motion control device is attachable anddetachable by the operator within the field of imaging. As will beappreciated by those skilled in the art, other devices adapted andconfigured to control movement of a target patient anatomy can be usedwithout departing from the scope of the disclosure.

Turning now to FIGS. 5A and 5B, an illustration of a configuration of ahorizontally configured motion control device 25 is provided forpurposes of illustration. The base 31 serves as the base for thehorizontally configured motion control device 25. The device 25 can beadapted and configured such that all other sub-systems attach or engagethe base in some way. The base 31 can be optionally adapted andconfigured to detachably attach to either the floor, the imagingequipment, and/or a posture-assistance device 53 via the detachableanchoring device 55. The operator can then remove the motion controldevice 25 from the field of imaging. Moving up from this base 31, thenext two physical sub-systems are the static platform 33 and the motionplatform 35. The static platform 33 and the motion platform 35 areattached to each other by a suitable mechanism such as a hingingmechanism 73. When the device is in the “default” position, shown inFIGS. 5A and 5B, the device is locked such that the flat surfaces ofboth the motion platform 35 and static platform 33 reside within thesame plane, but that still allows for the free rotation of the motionplatform 35 within a plane (e.g., plane a-c) of its subject-facingsurface about a fixed axis (b) of rotation. Other configurations orembodiments are possible that afford for the horizontal motion platformto move in a plane that is at an angle to the horizontal staticplatform. These “non-default” configurations are described in detaillater in subsequent drawings.

The static platform 33 and motion platform 35 attach to the base 31differently. See FIGS. 5A and 5B for a graphical description of howthese sub-systems can be adapted to attach to each other. In thisdevice, the base 31 attaches to either the floor, imaging equipment,and/or posture assistance devices 53 via the detachable anchoring device55 and also connects to the static platform 33, which is held firm by arigid immobilized static platform/member attachment mechanism 49. Thebase 31 and the motion platform 35 are attached by way of the motionplatform attachment mechanism 51 that along with the hinging mechanism73 allows for free rotation of the motion platform 35 within the planeof its flat subject-facing surface, while simultaneously allowing forthe adjustment of the angle that this plane makes with thesubject-facing surface of the static platform 33, such that these twoplanes intersect along the line of the hinge which occupies the linearspace defined by the edges of these two platforms that face and areadjacent to each other. In the “default” configuration represented inFIGS. 5A and 5B, this angle is set to 180 degrees. In other“non-default” configurations, this angle can be adjusted to angles otherthan 180 degrees. The radio-opaque protractor 74 is shown on FIG. 5A.FIGS. 5C-E illustrate a configuration of a suitable device.

FIGS. 6A and 6B illustrate the functionality of the motion platformattachment mechanism 51 and the hinging mechanism 73. FIG. 6A depictsthe side view block diagram of attachment mechanisms and parts of thehorizontally configured motion control device 25 in a “front up”configuration, where the hinging mechanism 73 connects the staticplatform 33 with the motion platform 35 along the edges of theseplatforms that face each other in such a way as to allow these twoplatforms to rotate about an axis c of the hinge. In this configuration,the connection between the base 31 and the static platform 33 is heldfirm by the rigid immobilized static platform/member attachmentmechanism 49. However, the motion platform attachment mechanism 51between the base 31 and the motion platform 35 functions differently.The motion platform attachment mechanism 51 is adapted and configured tolengthen within a plane (e.g., plane a-c) along an axis as well as theability to change the angle of attachment to both the base 31 and themotion platform 35 such that the end of the motion platform 35 opposingthe end adjacent to the static platform 33 can move up or down (alongthe b axis) so that the plane of the motion platform 35 is at an angleto the plane of the static platform 33 and that these two planesintersect along the line created by their common edge which is a spaceoccupied by the hinging mechanism 73. A radiopaque protractor 74 (shownin FIG. 7B) enables an assessment of movement of the spine during theimaging process.

FIG. 6B represents a side view block diagram of attachment mechanismsand parts of a horizontally configured motion control device 25 in a“front down” configuration. In this configuration, the hinging mechanism73 functions in the same way allowing for the static platform 33 andmotion platform 35 to rotate about the axis c of the hinge such that itchanges position from lying within a plane (e.g. c-a plane) to rotatingabout the c axis. The rigid immobilized static platform/memberattachment mechanism 49 in this configuration can be lengthened orshortened, but fixed at a right angle to the platform base 31 and thestatic platform 33. The motion platform attachment mechanism 51 can belengthened or shortened such that the angle of attachment to the motionplatform 35 and the platform base 31 is no longer a right angle, andinstead any other angle dictated by the geometric configuration of thedevice indicated by the prescriber.

As reflected in FIGS. 7A and 7B, the frame 31 connects to the base 53 ofvertically configured motion control device 27 at a rigid base to frameconnection mechanism 69. The frame 31 is the frame to which all othersub-systems attach in some way. Moving out from this frame 31, the nexttwo physical sub-systems are the static member 33 and the motion member35. The frame 31 attaches to the static member 33 by way of a rigidimmobilized static platform/member attachment mechanism 49 like the onedescribed for FIGS. 5A and 5B with the added capability of providingcantilevered support for the weight of the static member 33 and any ofthe attached subject body parts. The frame 31 attaches to the motionmember 35 by way of a motion member attachment mechanism 85 that allowsfree rotation around a fixed axis within the same plane as that of thesubject facing surface of the static member, and provides for thecantilevered support for the weight of the motion member 35 and thesubject body parts that could be connected to it. The static member 33and motion member 35 and are attached to each other by the verticallyconfigured motion control device hinging mechanism 73 that when in the“default” position represented in FIGS. 7A and 7B, is locked such thatthe flat surfaces of both the static member 33 and the motion member 35reside within the same plane, but still allows for the free rotation ofthe motion member 35 around a fixed axis within that plane. Aradio-opaque protractor 74 adaptable for use with any device disclosedor contemplated to be part of the system is shown on FIG. 7B. FIGS. 7C-Eillustrate a configuration of the device.

FIGS. 8A, 8B, and 8C represent the side view block diagram of thevertically configured motion control device 27 in the “default”, “topout” and “top in” configurations, respectively. The “default”configuration given in FIG. 9A is as described in the previousparagraph. In FIG. 9B, the “top out” configuration, the attachmentmechanism 85 connects the static member 33 to the motion member 35 andcan lengthen or shorten along the b axis and/or change the angle ofattachment to frame 31 and motion member 35 such that the top of themotion member 35 can move away from the frame 31 so that the plane ofthe motion member 35 is at an angle to the plane of the static member 33and that these two planes intersect along the line created by theircommon edge, the space of which is occupied by the motion control devicehinging mechanism 73. Furthermore, the motion member attachmentmechanism 85 allows for the free rotation of the motion member 35 arounda fixed axis within that plane while providing cantilevered supportingthe weight of the motion member and any of the subject's body parts thatare connected to it.

In FIG. 8C, the “top in” configuration, the motion member attachmentmechanism 85 illustrates its ability to lengthen and shorten along the baxis and change the angle of attachment to the connecting frame 31 andmotion member 35. Additionally, in this configuration, the staticplatform/member attachment mechanism 49 can lengthen along b axis,pushing the static member 33 away from the frame 31 while keeping thestatic member 33 in a non-changing orientation with respect to the frame31.

VIII. SOFTWARE PROGRAMS IMPLEMENTABLE IN THE COMPUTING AND NETWORKENVIRONMENTS TO ACHIEVE A DESIRED TECHNICAL EFFECT OR TRANSFORMATION

FIG. 9 is a simplified block diagram of the integrated imaging system.There is an imaging component, and a tracking component both of whichcommunicate through the central imaging control unit through a series offeedback loops. The imaging component is any suitable imaging device,such as those disclosed above. The tracking component can be anysuitable device such as those disclosed above that facilitates trackingand movement of a target patient anatomy.

It is contemplated that the imaging and tracking component are part ofthe same machine, but it is possible that the imaging and trackingcomponents are separate units connected through either a wirelessconnection or a direct wire connection to each other or through anexternal imaging control unit.

The components of the tracking system and the imaging apparatuscommunicate information through the imaging control unit and theinformation is used to direct adjustments in real time to the imagingdevice. The purpose of this invention is to provide the best diagnosticimaging information to the physician and patient and to reduce radiationexposure to the patient and or physician during the testing session

The first component of the integrated imaging system is the imagingcomponent. While the following description refers to fluoroscopicimaging in general, it is contemplated that the advantages also appliesto many types of diagnostic imaging systems. Further informationregarding fluoroscopic devices is provided, for example, in U.S. Pat.No. 6,424,731 for Method of Positioning a Radiographic Device; and U.S.Pat. No. 5,873,826 entitled Fluoroscopy method and X-ray CT apparatus.

Referring to FIG. 9, the basic components of the imaging system areshown. The imaging apparatus includes a central image control unit thatcontrols, among other things, the intensity of the imaging source, theduration of the scan, the optimal frequency of images (frames persecond), the position of the imaging source, and the optimalcollimation. There is also an image storage unit that acquires theinformation from the imaging session and stores the image or imagesequence for review. There is also an image viewing station for realtime viewing of the image or image sequence. The image viewing stationalso acts as the tracking apparatus monitor where an operator wouldinput information with respect to the area or areas of interest withinthe field of view of the image.

The components of the diagnostic tracking system are a user inputcomponent and computer hardware and software component. While it iscontemplated that the tracking display unit is also the image viewingstation, those skilled in the art will appreciate that it can also be aseparate viewing station independent of the image viewing station andwhich communicates with the central image control unit either through asecure wireless connection or through a direct wire connection.

The user input component provides the user with the capability ofdefining one or more areas of interest within the image based on thediagnostic test that is prescribed. In real time, the computer hardwareand software component calculates the location of the area of interestand records and communicates this information for several purposes.

One such purpose for the tracking information of the location of thearea of interest is for the purpose of acquiring an imaging session thatprovides optimal diagnostic information and minimal exposure toradiation. This is accomplished through feedback loops to the centralimage control unit. The information derived from the tracking apparatusdirect changes with respect to the imaging session.

For example, one such feedback loop connects a real time, or nearreal-time, tracking information with the positioning of the x-ray sourceso as to keep the area of interest within the field of view throughoutthe imaging session. This is accomplished through either a wirelessconnection or a direct wire connection that transmits information withrespect to the position of the area of interest within the central areaof the field of view of the image. The information is received in realtime by the central image control unit, processed, and the output is acontinuous adjustment to the location of the imaging source with respectto the patient so as to keep the area of interest centered within thefield of view throughout the image testing session.

Another feedback loop would use the tracking information toautomatically and continuously, or semi-automatically if desired by auser, adjust the collimators so as to direct the radiation to the areaof interest and at the same time decrease radiation exposure to thepatient. The tracking information transmits information with respect tothe location of the area of interest within the field of view of theimage to the image control unit through a wireless or a direct wiredconnection. The image control unit processes the information andautomatically and/or continuously adjusts the image settings withrespect to the image apparatus collimators. Those skilled in the artwill appreciate that this system can be adapted and configured for usewith different types of collimators that are already available, and withthose that are not yet developed.

Another feedback loop would use the tracking information to adjust theintensity of the radiation so as to produce an image that issufficiently defined for the purposes of the diagnostic testingrequirements. With respect to this feedback loop, the tracking softwaretransmits information either wirelessly or through a direct wiredconnection to the image control unit. The image control unit thenprocesses the information and automatically and/or continuously adjuststhe image settings with respect to intensity of the radiation source.One example of the image source settings that might be adjusted based onthe imported information could be the fluoroscopic kv and mA. Thesetypes of adjustments might change the contrast levels in the image orreduce noise associated with radiation imaging.

Another feedback loop would transmit the tracking information to theimage control unit so as to provide information with respect to theoptimal distance of the image intensifier from the patient. The trackinginformation would be transmitted either wirelessly or through a directwire connection. The imported information would be processed by theimage control unit and direct continuous adjustments to the imageintensifier in real time for the purpose of creating the optimal imagingsession for the prescribed diagnostic testing session.

Another feedback loop would transmit the tracking information to theimage control unit so as to provide information with respect to theoptimal fluoroscopic exposure rate at the image intensifier. Thetracking information would be transmitted either wirelessly or through adirect wire connection. The imported information would be processed bythe image control unit and used to adjust the fluoroscopic exposure rateat the image intensifier continuously and in real time. The rate ofexposure with respect to frames per second might depend on the rate atwhich the area or areas of interest are moving during the testingsession.

For all of these situations, more accurate information with respect toimage source location, intensity and collimation will reduce radiationexposure to both the patient and to the operator. It is contemplatedthat there are other aspects of the imaging session that can becontinuously adjusted in real time during the imaging session so as toimprove the quality of the images, create the optimal imagingenvironment, produce the best diagnostic imaging information andminimize the radiation exposure to the patient.

As will be appreciated by those skilled in the art, for all of thesefeedback loops automatically and continuously communicating instructionsbased on the feedback loops and the images can include, for example,transmitting a new instruction which changes one or more settings,transmitting an instruction which maintains the most recent one or moresettings, transmitting an instruction that repeats an earlier one ormore instructions, or providing no change in instruction in currentinstructions. Where no change instructions are provided, the systemand/or one or more feedback loops can be adapted and configured toautomatically repeat the most recent instructions after a lag of a setamount of time from providing the image data for analysis. Thus forexample, if a feedback loop is processed and a period of n secondspasses the prior setting will remain in place.

IX. EXAMPLES

A process by which this disclosure can be implemented is shown in FIG.11. The process begins with the patient being positioned in the startingposition for the prescribed imaging test. A spot image is acquired. Theoperator or physician determines whether the spot image captures thefield of view necessary for the prescribed imaging test. If the patientis not in the correct position, the operator or physician willreposition the patient and repeat the process. Once the area of interestfor the prescribed imaging test is within the field of view of theimage, the operator or physician will manually defined the area ofinterest. For example, this could be defining one or more vertebra ofthe spine for a flexion extension testing session. Once the areas ofinterest are defined, the imaging session begins. During the imagingsession, the tracking apparatus tracks the area or areas of interestwithin the image in real time. The information with respect to imagequality and position of the area or areas of interest are communicatedfrom the tracking apparatus to the central imaging control unit. Thecentral imaging control unit processes the information in real time, andautomatically and continuously adjusts the imaging apparatus so as tomaintain optimal imaging settings for the prescribed testing session. Atthe completion of the imaging testing session, the image results aredisplayed both as a video of the imaging session and the quantitativediagnostic information is also displayed. Finally, the information isstored and can be recovered for future reference.

It is contemplated that this apparatus can incorporate the use of manydifferent external devices that might be used in conjunction with adiagnostic imaging session. For example, if an apparatus that controlsthe motion of the patient during the testing session is used, theinformation from that device will also communicate with the centralimaging control unit and implement the same feedback loops as describedabove. The motion apparatus can be used in conjunction with the imagingsystem as a means of standardizing or supporting patient motion duringthe imaging session. The motion apparatus is comprised of a patientmotion control unit that interacts and moves a patient undergoing animaging session in a controlled, predetermined motion path. It iscontemplated that the motion apparatus communicates information with theimaging device with respect to the position of the table and/or thepatient on the table during imaging. It is also contemplated that themotion apparatus can adjust based on the position of the imaging device.The motion table may adjust for example to maintain the same image fieldof view throughout the motion testing session. It is possible for eachcomponent of the motion apparatus to communicate or receive informationthrough a central processing unit.

While the previous description describes a motion control device used inconjunction with the integrated imaging system, those skilled in the artwill appreciate that this is only one example, and there are many typesof external apparatus' that can be used during an imaging session, andit is contemplated that each such device could be incorporated into thisinvention.

Functional tests of a target subject anatomy, such as the spine, can beperformed to minimize the radiation dose involved during a procedurewith an imaging procedure based on real-time or near real-time feedback.A patient would be positioned on the articulating patient handlingdevice and prepared for an imaging study. The imaging study wouldinvolve the capturing of images of the lumbar spine with a standardhospital fluoroscope, which is capable of capturing moving x-ray typevideo images of the lumbar spine. The fluoroscope would then beginrecording images as the patient handling device affects a controlledmovement of the subject during the imaging session. During a traditionalimaging session, the field of imaging for standard fluoroscopes istypically a 9 or a 12 inch circle. For a lumbar vertebrae of interestthe vertebra only occupies a small subset of this imaging field—on theorder of 15-30% of the imaging field—however the entire imaging field isbeing irradiated and imaged. By providing a real-time or near real-timetracking system the exact position and trajectory of the target anatomycan be determined, then fed back into a collimator. The collimator wouldthen be placed on the X-ray generator, and would be able to adjust theshape and trajectory of the collimation of the X-ray beam according todata received from the tracking system to prevent regions other thanthose of interest (i.e. the lumbar vertebral bodies) from beingirradiated and imaged. The data capture, analysis and feedback loopwould then reduce the overall radiation dose to the patient proportionalto the proportion of the beam that is being collimated.

Yet another example provides an improved functional test of a targetanatomy allows smaller image intensifiers to be used. Currently, asdiscussed above, standard hospital fluoroscopes have a 9 or a 12 inchimage intensifier, and therefore a corresponding 9 or 12 inch field ofview. When imaging the lumbar spine in motion, it is often the casethat, in the case when a subject is moving their torso to affect alumbar bend, superior lumbar vertebrae such as L1 or L2 move out of the9 or 12 inch field of view as a patient approaches a maximum lumbarbending angles. Real-time or near real time adjustments to the anatomycontained within the field of view would make it possible to prevent orminimize the target anatomy from exiting the field of view duringimaging through a movement sequence.

Two different mechanisms can be provided to prevent or eliminatemovement of the target anatomy from the field of view. By providing areal-time tracking capability that allows a computer implemented systemto precisely monitor the position of the vertebral bodies duringimaging, the present invention provides for a feedback loop from thereal time tracking system to either the positioning system for thefluoroscopy or the positioning system on which the articulating patienthandling device rests. By making adjustments to either the position ofthe image intensifier and/or to the articulating patient handling deviceassembly, it would be possible to maintain all anatomy of interestwithin the field of view at all points during the movement and preventany anatomy from exiting the field of view. The effect of this is thatless expensive fluoroscopy systems with smaller image intensifiers wouldbe suitable for conducting imaging of, for example, the lumbar spineduring controlled lumbar bending.

A problem associated with functional test of the spine is variability.Clinical studies that have shown that there can be a wide degree ofvariability in measurement of in vivo lumbar vertebral motion. Onesystem to reduce the variability is to standardize the bending angle towhich subjects bend during imaging. However even when standardizingbending angle, there can still be variability with respect to the totalamount of lumbar bending that is occurring during a particular imagingsession. The total amount of lumbar bending that is occurring can bemeasured by measuring the angulation between L1, the uppermost (or mostsuperior) lumbar vertebra, and S1, the lowermost (or most inferior)lumbar vertebra. This overall L1-S1 angulation is measured by comparingtwo X-ray or fluoroscopic images of a subject taken from two differentpositions. For example, a subject might perform a gross lumbar bend andachieve 60 degrees of gross lumbar bending, but the L1-S1 angulationmight only by 45 degrees. The difference is attributable to mechanicalslack in other anatomy involved in the motion, such as the hips, thorax,arms, shoulders, etc. By standardizing the overall L1-S1 angulation of asubject instead of the motion control device, and by taking measurementsof the motion of individual vertebral bodies at standardized L1-S1angles as opposed to standardized gross bending angles, it is possibleto further reduce intervertebral angulation measurement variability.Therefore an advantage afforded by the present invention would be tohave subjects bend to a standardized L1-S1 angle, letting the overallgross bending angle vary, as opposed to bending subjects to astandardized gross bending angle and letting the L1-S1 angle vary. Thereal-time or near real-time feedback loop from the tracking system tothe articulation control system of the patient handling device enablesthe device to discontinue imaging when an actual patient bending anglehas been achieved. Such a feedback loop would allow a diagnostician toselect a range of motion and then for the subject to be guided through astandard bend that would continue until a selected or specified L1-S1angle was achieved. The real time tracking system would provide themeans of signaling to the articulation control system that the subjecthas achieved a specific L1-S1 angle, and therefore that bending shouldbe stopped and reversed in the opposite direction to return the subjectto a neutral position. Such a system would provide the capability toproduce lower variability intervertebral angulation measurements.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments of the invention describedherein may be employed in practicing the invention. It is intended thatthe following claims define the scope of the invention and that methodsand structures within the scope of these claims and their equivalents becovered thereby.

What is claimed is:
 1. A system measuring skeletal joint motion in asubject comprising: a) a motion device means adapted and configured tocontinuously move a joint of the subject, the motion device meanscomprising: a platform base means, and a motion platform means furthercomprising a static platform means connected to an upper surface of theplatform base means, a movable platform means connected to at least oneof the static platform means or an upper surface of the platform basemeans, wherein the static platform means is adjacent the movableplatform means wherein movement of the movable platform means isachieved in operation by a motor in communication with the moveableplatform means; b) an imaging device in communication with the motiondevice means adapted and configured to obtain imaging data; and c) acomputing system adapted and configured to analyze the obtained imagingdata to generate an instruction and then communicate the instruction toat least one of the motion device means and the imaging device whereinthe computing system is configurable to receive information from atleast one of the motion device means and the imaging device during animaging session; analyze the received information during the imagingsession; determine whether a target anatomy is within a field of viewduring the imaging session; evaluate a position of the imaging device, aposition of the motion device means, a radiographic imaging technique,and a geometric configuration of a collimator; determine whether achange to one or more of a position of the imaging device, a position ofthe motion device means, a radiographic imaging technique, and ageometric configuration of a collimator will bring the target anatomywithin the field of view; and instruct at least one of the motion devicemeans and imaging device to change an imaging environment automaticallyand continuously during the imaging session to maintain the targetanatomy within a field of view by one or more of changing the positionof the imaging device, changing the position of the motion device means,changing the radiographic imaging technique, and changing the geometricconfiguration of the collimator.
 2. The system of claim 1, wherein theimaging device is an X-ray tube and image intensifier with dosagecontrol.
 3. The system of claim 1, wherein the imaging device is amagnetic resonance scanner.
 4. The system of claim 1, wherein theplatform is a laterally moveable platform.
 5. The system of claim 1,wherein the movable platform means is situated on a support means whichlies on the upper surface of the platform base means.
 6. The system ofclaim 5, wherein the imaging device is an X-ray tube and imageintensifier with dosage control.
 7. The system of claim 6, wherein theimaging device is a magnetic resonance scanner.
 8. The system of claim1, further comprising a control arm means for driving movement of themoveable platform means.
 9. The system of claim 1 further comprising aprocessing system.
 10. The system of claim 1 wherein the motion devicemeans is adapted to communicate motion information to the imaging deviceduring use.
 11. The system of claim 1 wherein continuous adjustments aremade to an imaging environment.
 12. The system of claim 11 wherein theinstruction changes an aspect of an imaging field.
 13. The system ofclaim 11 wherein the instruction changes a movement of a motion devicemeans.
 14. The system of claim 1 wherein a range of motion of the motiondevice means is based on a selected target motion for a patient.
 15. Thesystem of claim 1 wherein a range of motion of the device is based on agross motion of a patient.